The URL can be used to link to this page

Home My WebLink About10090-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N.Y, Certificate Of Occupancy Zg?h.7 Date No'~elaber ~ 5 19 79 THIS CERTIFIES that the building ................................................ Location of Property :~895 Iqells Avenue 8Our:hold House No. Street Hamlet County Tax Map No. 1000 Section 070 .Block /* .Lot l~ .9.t;o 12 -.1~ Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated December 29 ,19.7.?. pursuant to which Building Permit No. 10090Z dated December 29 19 78, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... '1~o 8t:or'y addition t;o existing One ~.a~. tly D~elllng Harriet E.G.am. per __ The certificate is issued to ........... [oJn'e'r,'i"J~'$~o"'r'X~ ................... of the aforesaid building. Suffolk County Department of Health Approval .......... I~../.R ............................. N451469 UNDERWRITERS CERTIFICATE NO .................................................. Building Inspector Rev 4/79 FOI~I~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 10090 Z Building Inspector, Fee $.. f.~......?.. .... THE NEW YORK BOARD OF FIRE UNDERWRITERS BUREAU OF IELI~CTRICITY ~[ JOHN ~'TI~I~T. NEW YORK. NEW YORK 10038 1-SmOke Der. Llc.282 be id~nlif~d b Af,4P ,9~ ~,~OP£f47'~f' FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topogra ph ic featu res. 2. Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. Bo For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date..~ !~:A ~.e .5.)..~,c~, .~ ..~ .... New Building ............. Old or Pre-existing Building ~ ......... Vacant Land ............. Location of Property .~.c~..~ ~ ................. .[0~ .L-.L,~.. ~.~C.{.~.~....~.t~.t0.~'.t.~.~,. ~.... House No. Street Ham/et Owner or Owners of Property . ~ ~ .... ~.~../~.t'~,)~[ ~,T...~-.:..~-~. ~ ~.~,/'~, ................ County Tax Map No, 1000 Section ............... Block ............... Lot ....... I' Subdivision ................................. Filed Map No ........... Lot No. Permit No.~ .O.~.O.~ .~..~.. Date of Permit'.~. 17-c(.t~[ '.~.Applicant .~,-~/~.('.~P-'~.~-~...~-'~....~-.~--~)~ Health Dept. Approval ........................ Labor Dept. Approval ........................ Underwriters Approval ............... _. (, .~ ..... Planning Board Approval ...................... ~equest tot aemporary L;ertificate ..................... Final Certificate ....................... Fee Submitted $....~.;o~o .................... Construction on above described building and permit meets all applicable/9~des and regulations. Applicant ...... .~ ............ ~'q~. · .1~ ......... ~ ............ ; .... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, ............. , praved ............. , ^pp,cotion No../.~.~..~.~ ........... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o· This application must be completely filled in by typewriter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets az areas, and giving o detailed description of layout ofproperty must be drown on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the~' Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ' 'r Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described· j The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in, buildings for necessary inspections. ..... , (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. (~ ~-N-C~ ................................................... .-'1..~l...~.~.~. ................ r.~.~.~.~. ................................................................... Name of owner of premises .............. .J~l~.,...~.~ll~..~.....~'..'--...~.~.~-.~.~ .......................................................... If app,,cant is a corpo~te, sj/~nature of duly authorized officer. ........ ~..~.......~~..¢.t .~... ~(Name and title of/corporate officer) Builders License No..t./~ .......................................... Plumber's License No.../.~......~)~,~.~.......~..~.,,/.~..y.~.z..~ Etectr~cian's License No.~ ........ !J ............................... Other Trade's License No ............................................... Location of land on which proposed.~_l,, ~.1 ~.1 k~,~w°rk will. b~e done. Ml~p ~N~.: ._.._~..~1.~'. J...-..~, ................. Lot No.~..~..~...Z.i~i..~.~. ~.../'~'""~':'/'"'/'~"~:/~ Street and Number ...................~..I..C~.......'~..~-.k,,.~,~,....~...'l.v.~.'~..'~,,.~. ............................................. ..~ Z ~'~-~ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy ................ ..~.I.t~.~-.~.~,.~.....~T.l~.(~JLb.~......~'~.~l.(}~'1..~...~..~ ................................ b. Intended use and occupancy .................... ...~..$.i~..{,~,......~.~{k4.t{w.~......J~/,;.'~b{).~,l~,.~. ............................ 3. Natu~.e ff Work (check which applicable): New Buildiag~· ................. Addition ............. __ Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... · · _ ~ _ ~ ~! ~-'~ (Description) 4. Estimated Cost ........ '~..~..~......~..~.. .................................. Fee ....~.~.~....~.~ ........................................................................ (to be paid on filing this application) ~r~'~if dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. w~. ' f business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ I Rear 7. Dimensions of existing structures, if any: Front ....... --...'~e..~.......} ...... ....... .................. Depth ........... · t Height ....... .~..I ........... Number of Stones ..................... [..L~, ................................................................................... Dimensions of same structure with alterations or additions: Front ........ .~,~.~.! .................. Rear ....~..~ ................. Depth ........ ..--I...¢~ ................ Height ........ ~,.~ ............. Number of Stories .....~.~,~..¢~.. ............... 8. Dimensions of entire new construction: Front .......... ..~..~, .................... Rear ...... .~...~ ................. Depth ...~,..~ ............... Height ....'~..~ ......... Number of Stories .................. ..~.~ ........................................................................................ 9. Size of lot: Front ..............'~.~! ................................. Rear ...... ,[...~..~..~. ....................... Depth ....... ..'~....~..O...t. ........... 10. Date of Purchase ................................... .I..e't..'1..~ ........ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ..I.~.~ .............................................. 13. Will lot be regraded ....t.~.¢~. ................ Wil/excess. fillbe,, removed from premises: (,) Yes t~ No 14. Name of Owner of prem,sesl~'%.*..I.{t~t~,~i..~..~'....~. ~t~.~...' ' ' Address ....~.~.C' ....~.'~.t.'['.~Z Phone No ....................... Name of Architect ~D.~,~...~.:...~..~.~..t.~.~..~..~.~.,/~ ~ ,~..~... .......... Address~).~.~.~ ...... Phone No.~/.~,.~..-..~,,~.I.L.. Name of Contractor ~,t~;~,~...[~,,.,..~,l~,~.C.'..~;~,'i.L~J..~..: Address ~l~."~.tZt~..~.t~.... Phone No.~,~?l.l~..'...~'."J.J.~. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. N,T, sworn, deposes and says that he is the applicam STATE OF NEW YORK, , icc ' COUNTY OF '~F..DI~.~,-~.. ........... ~'~ ................... ...~.I~4~.C"~'~.' ...ff.....~.~.~' ~' : ..... be,ng' duly (Name of individual signing contract) abow~ named. He is the .............. ~.~ ~Z~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make ~nd file this application; that ali statements contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. ..... ~ ~ ~.... day ~,~..~~ ~ Nota~ Public,N<~,/,[ v ..;(~~ ~..~~n~ I~ur~, ,c, 1.:~k~'m ~,t,~.~ Now vo4< .......... xx~ (Si~oture .......................... of ~plic~nt) NOT RESPONSIBLE FOR DESIGN OR CON~',T~UCTION E~ORS ALL CONSTRUCTION MUST ME~ REQUIREMENTS OF N.Y. STATE CODE ' AND TOWN HOUSING CODE & ZONING 4'. ,~-r-r~o") / J¢ F.~i~TI pJ,F~ 'f : i